{"title":"Cost-effectiveness of saxaglipitin in the Brazilian supplementary health system","authors":"Ítalo Martins de Oliveira","doi":"10.1016/S2255-4823(13)70438-7","DOIUrl":"10.1016/S2255-4823(13)70438-7","url":null,"abstract":"","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 2","pages":"Page 101"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70438-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76309941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wanderley M. Bernardo, Livia Brassolatti Silveira, Bruna Melchior Silvia, Bruno de Oliveira Ribeiro, Karina Rocha Maciel, Larriane Barbieri Favero, Julio Sérgio Marchini, Renata Ferreira Buzzini
{"title":"Update on zinc supplementation in the treatment of anorexia nervosa","authors":"Wanderley M. Bernardo, Livia Brassolatti Silveira, Bruna Melchior Silvia, Bruno de Oliveira Ribeiro, Karina Rocha Maciel, Larriane Barbieri Favero, Julio Sérgio Marchini, Renata Ferreira Buzzini","doi":"10.1016/S2255-4823(13)70499-5","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70499-5","url":null,"abstract":"","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 5","pages":"420-420"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70499-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72283423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Asthma during pregnancy: effects on fetal well-being, and maternal and perinatal complications","authors":"Renata Franco Pimentel Mendes , Roseli Mieko Yamamoto Nomura , Cristiane Ortigosa , Rossana Pulcineli Vieira Francisco , Marcelo Zugaib","doi":"10.1016/S2255-4823(13)70443-0","DOIUrl":"10.1016/S2255-4823(13)70443-0","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications.</p></div><div><h3>Methods</h3><p>A retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteria were as follows: singleton pregnancy; pregnant women diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28<sup>th</sup> week of pregnancy; birth at this institution; newborn weighing over 500<!--> <!-->g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed.</p></div><div><h3>Results</h3><p>Of the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056<!--> <!-->g (SD 581g). The fetal biophysical profile performed during the antepartum period (n<!--> <!-->=<!--> <!-->90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n<!--> <!-->=<!--> <!-->28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p<!--> <!--><<!--> <!-->0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p<!--> <!-->=<!--> <!-->0.039).</p></div><div><h3>Conclusion</h3><p>The severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 2","pages":"Pages 113-119"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70443-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86348368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roseli Mieko Yamamoto Nomura , Rodolpho Truffa Kleine , Ana Maria Kondo Igai , Rossana Pulcineli Vieira Francisco , Marcelo Zugaib
{"title":"Clinical and obstetrical management of pregnant women with autoimmune hepatitis complicated by moderate or severe thrombocytopenia","authors":"Roseli Mieko Yamamoto Nomura , Rodolpho Truffa Kleine , Ana Maria Kondo Igai , Rossana Pulcineli Vieira Francisco , Marcelo Zugaib","doi":"10.1016/S2255-4823(13)70426-0","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70426-0","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the management of prenatal care and delivery in patients bearing autoimmune hepatitis associated with moderate or severe thrombocytopenia.</p></div><div><h3>Methods</h3><p>This study was performed in a tertiary level university hospital. Thiteen pregnancies in ten patients diagnosed with autoimmune hepatitis, complicated by thrombocytopenia, were retrospectively analyzed. The inclusion criteria were as follows: clinical diagnosis of autoimmune hepatitis, moderate or severe thrombocytopenia (platelet count < 100 × 10<sup>3</sup>/mm3), gestational age at birth over 22 weeks, and patient followed-up by a specialized team at the institution. The variables studied were: maternal age, parity, treatment regimen, platelet count, examinations for investigation of hepatic function, type of delivery, weight at birth, and gestational age at the time of delivery.</p></div><div><h3>Results</h3><p>The average maternal age was 24.5 years (SD<!--> <!-->=<!--> <!-->5.3) and six (50%) occurred in nulliparous women. During pregnancy, monotherapy with prednisone was adopted in 11 cases (92%). According to the autoantibody profiles, seven pregnancies (58%) had the autoimmune hepatitis type I diagnosis, two pregnancies had type II (17%), and three pregnancies (25%) had cryptogenic chronic hepatitis (undetectable titers of autoantibodies). Portal hypertension was featured in 11 pregnancies (92%). The average gestational age at delivery was 36.9 weeks (SD<!--> <!-->=<!--> <!-->1.5 weeks), with an average weight at birth of 2,446g (SD<!--> <!-->=<!--> <!-->655g). Eight infants (67%) were small for gestational age. At the time of delivery, severe thrombocytopenia was featured in four cases (33%) and cesarean surgery was performed in seven cases (58%). Complications at delivery occurred in three cases (25%), one patient presented uterine atony, and two patients presented perineal bruising. There was no perinatal or maternal death.</p></div><div><h3>Conclusion</h3><p>The complications of thrombocytopenic patients with autoimmune hepatitis are elevated; nevertheless, with appropriate attention and care, they can be resolved. The association between two severe pathologies appears to increase the risk of prematurity and fetal growth restriction, demanding specialized prenatal care, as well as surveillance of fetal well-being.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 1","pages":"Pages 28-34"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70426-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91637546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Denis Barbosa Cacique , Renato Passini Junior , Maria José Martins Duarte Osis
{"title":"Content validation of the ‘Mosaic of Opinions on Abortion’ (Mosai)","authors":"Denis Barbosa Cacique , Renato Passini Junior , Maria José Martins Duarte Osis","doi":"10.1016/S2255-4823(13)70522-8","DOIUrl":"10.1016/S2255-4823(13)70522-8","url":null,"abstract":"<div><h3>Objective</h3><p>This study is aimed to develop and validate the contents of the <em>Mosaic of Opinions on Induced Abortion</em> (Mosai), a structured questionnaire intended to be used as a tool to collect information about the views of health professionals about the morality of abortion.</p></div><div><h3>Methods</h3><p>The contents of the first version of the questionnaire was developed based on the technique of thematic content analysis of books, articles, films, websites and newspapers reporting cases of abortion and arguing about their practice. The Mosai was composed of 6 moral dilemmas (vignettes) related to induced abortion, of which outcomes should be chosen by the respondents and could be justified by the classification of 15 patterns of arguments about the morality of abortion. In order to validate its contents, the questionnaire was submitted to the scrutiny of a panel of 12 experts, an intentional sample consisted of doctors, lawyers, ethicists, sociologists, nurses and statisticians, who evaluated the criteria of clarity of writing, relevance, appropriateness to sample and suitability to the fields. These scores were analyzed by the method of concordance rate, while the free comments were analyzed using the analysis technique content.</p></div><div><h3>Results</h3><p>All the moral dilemmas and arguments were considered valid according to the rate of agreement, however, some comments led to the exclusion of a dilemma about emergency contraception, among other changes.</p></div><div><h3>Conclusion</h3><p>The content of Mosai was considered valid to serve as a tool to collect the opinions of healthcare professionals regarding the morality of abortion.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 6","pages":"Pages 576-582"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70522-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"110641583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renan Kleber Costa Teixeira , Nara Macedo Botelho , Andy Petroianu
{"title":"References of Brazilian Medical Journals in national publications","authors":"Renan Kleber Costa Teixeira , Nara Macedo Botelho , Andy Petroianu","doi":"10.1016/S2255-4823(13)70521-6","DOIUrl":"10.1016/S2255-4823(13)70521-6","url":null,"abstract":"<div><h3>Objective</h3><p>To assess whether there is a preference for international journal citation to the detriment of national ones in ten Brazilian medical journals, in two different periods.</p></div><div><h3>Methods</h3><p>All references in the articles published in Arquivos Brasileiros de Oftalmologia, Revista Brasileira de Cirurgia Cardiovascular, Revista da Associação Médica Brasileira, São Paulo Medical Journal, Arquivos Brasileiros de Endocrinologia e Metabologia, Clinics, Jornal Brasileiro de Pneumologia, Revista da Sociedade Brasileira de Medicina Tropical, Revista Brasileira de Psiquiatria e Acta Ortopédica Brasileira in the years 2011 and 2007 were analyzed, assessing the number of articles published in national and international journals.</p></div><div><h3>Results</h3><p>A total of 36,125 references from 1,462 articles published in the 10 aforementioned journals were analyzed. Of the total number, 4,242 (11.74%) were from Brazilian journals. There was no significant difference between the two analyzed periods. A total of 453 (30.98%) articles had Brazilian references and 81 (5.54%) articles had more national than international references.</p></div><div><h3>Conclusion</h3><p>Of total references analyzed, 11.74% were related to articles published in Brazilian journals. This number, when compared to the percentage of Brazilian articles published in the medical area, demonstrates a good number of citations of national articles.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 6","pages":"Pages 571-575"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70521-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85985598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anelise Dentzien Pinzon , Taís Sica da Rocha , Cláudia Ricachinevsky , Jefferson Pedro Piva , Gilberto Friedman
{"title":"High-frequency oscillatory ventilation in children with acute respiratory distress syndrome: experience of a pediatric intensive care unit","authors":"Anelise Dentzien Pinzon , Taís Sica da Rocha , Cláudia Ricachinevsky , Jefferson Pedro Piva , Gilberto Friedman","doi":"10.1016/S2255-4823(13)70489-2","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70489-2","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the effects of high-frequency oscillatory ventilation (HFOV) as a rescue ventilatory support in pediatric patients with acute respiratory distress syndrome (ARDS).</p></div><div><h3>Methods</h3><p>Twenty-five children (1 month < age < 17 years) admitted to a university hospital pediatric intensive care unit (ICU) with ARDS and submitted to HFOV for a minimum of 48 hours after failure of conventional mechanical ventilation were assessed.</p></div><div><h3>Results</h3><p>28 days after the onset of ARDS, the mortality rate was 52% (13/25). Over the course of 48 hours, the use of HFOV reduced the oxygenation index [38 (31–50) vs. 17 (10 - 27)] and increased the ratio of partial arterial pressure O<sub>2</sub> and fraction of inspired O<sub>2</sub> [65 [44–80) vs. 152 (106–213)]. Arterial CO<sub>2</sub> partial pressure [54 (45–74) vs. 48 (39–58)<!--> <!-->mmHg] remained unchanged. The mean airway pressure ranged between 23 and 29<!--> <!-->cmH<sub>2</sub>O. HFOV did not compromise hemodynamics, and a reduction in heart rate was observed (141<!--> <!-->±<!--> <!-->32 vs. 119<!--> <!-->±<!--> <!-->22 beats/min), whereas mean arterial pressure (66<!--> <!-->±<!--> <!-->20 vs. 71<!--> <!-->±<!--> <!-->17<!--> <!-->mmHg) and inotropic score [44 (17–130) vs. 20 (16–75)] remained stable during this period. No survivors were dependent on oxygen.</p></div><div><h3>Conclusion</h3><p>HFOV improves oxygenation in pediatric patients with ARDS and severe hypoxemia refractory to conventional ventilatory support.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 4","pages":"Pages 368-374"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70489-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137439378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriela Marodin , Jennifer Braathen Salgueiro , Márcia da Luz Motta , Leonor Maria Pacheco Santos
{"title":"Brazilian guidelines for biorepositories and biobanks of human biological material","authors":"Gabriela Marodin , Jennifer Braathen Salgueiro , Márcia da Luz Motta , Leonor Maria Pacheco Santos","doi":"10.1016/S2255-4823(13)70432-6","DOIUrl":"10.1016/S2255-4823(13)70432-6","url":null,"abstract":"<div><h3>Objective</h3><p>To characterize the participatory and democratic creation of the Brazilian guidelines for biorepositories and biobanks of human biological material with the purpose of research based on the ethical principles of human dignity, autonomy, beneficence, justice, and precaution.</p></div><div><h3>Methods</h3><p>An interdisciplinary work group was constituted to prepare the document, considering the following criteria: experience in biobank operation, regional representation, type of stored biological material, and bioethics specialists. Members of the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária – Anvisa), also participated due to their regulatory competence. Members from the National Commission on Ethics in Research (Comissão Nacional de Ética em Pesquisa – Conep) participated as the social control organization.</p></div><div><h3>Results</h3><p>The document, based on ethical, legal, and technical guidelines, presents the concepts, activities, purposes, and differences between biorepositories and biobanks; forms of consent on the part of the subject; in addition to other aspects permeated by concerns regarding the appropriate use of information. The Brazilian guidelines for biorepository and biobank of human biological material with the purpose of research contains 39 articles, which are distributed in five chapters.</p></div><div><h3>Conclusion</h3><p>The importance of legislation arises from the ethical concern, considering morals and taking into account the legal aspects, which translate into a document that does not end in itself. The dynamics of science always leads to changes in paradigms, which can go beyond the existing laws.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 1","pages":"Pages 72-77"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70432-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84664754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francisco J.B. Aguiar , Mario Ferreira-Júnior , Maria M. Sales , Luiz M. Cruz-Neto , Luiz A.M. Fonseca , Nairo M. Sumita , Nilo J.C. Duarte , Arnaldo Lichtenstein , Alberto J.S. Duarte
{"title":"C-reactive protein: clinical applications and proposals for a rational use","authors":"Francisco J.B. Aguiar , Mario Ferreira-Júnior , Maria M. Sales , Luiz M. Cruz-Neto , Luiz A.M. Fonseca , Nairo M. Sumita , Nilo J.C. Duarte , Arnaldo Lichtenstein , Alberto J.S. Duarte","doi":"10.1016/S2255-4823(13)70434-X","DOIUrl":"10.1016/S2255-4823(13)70434-X","url":null,"abstract":"<div><p>C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards, and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 1","pages":"Pages 85-92"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70434-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83952913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Foreign physicians: the language issue","authors":"Bruno Caramelli","doi":"10.1016/S2255-4823(13)70495-8","DOIUrl":"10.1016/S2255-4823(13)70495-8","url":null,"abstract":"","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 5","pages":"Pages 407-408"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70495-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77706634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}